McCoul Edward D, Goldstein Nira A, Koliskor Bernard, Weedon Jeremy, Jackson Alison, Goldsmith Ari J
Department of Otolaryngology, State University of New York-Downstate Medical Center, Brooklyn, NY 11203, USA.
Arch Otolaryngol Head Neck Surg. 2011 Jan;137(1):35-41. doi: 10.1001/archoto.2010.222.
To demonstrate improvements in validated quality-of-life measures for otitis media and gastroesophageal reflux disease (GERD) and an objective score for pediatric reflux obtained by fiberoptic laryngoscopy after treatment with antireflux precautions and therapy in children diagnosed as having either recurrent acute otitis media or otitis media with effusion and GERD.
Prospective, before-and-after intervention study.
Hospital-based pediatric otolaryngology practice.
Population-based sample of 47 patients (mean age, 19.5 months).
Standard antireflux therapy for 2 consecutive 12-week periods.
Otitis Media 6-Item quality-of-life survey, Infant GERD Questionnaire-Revised, GERD Symptom Questionnaire for Young Children, Pediatric Reflux Finding Score, and speech awareness threshold.
Follow-up data were available for 37 patients. Mean (SD) change scores for Otitis Media 6-Item quality-of-life survey were 1.6 (1.1) at visit 2 and 1.5 (1.1) at visit 3 (P < .001 and P = .004, respectively). Change scores were significantly improved for Infant GERD Questionnaire-Revised and GERD Symptom Questionnaire for Young Children at visit 2 and for Infant GERD Questionnaire-Revised at visit 3. Mean (SD) change scores for the Pediatric Reflux Finding Score were 6.4 (4.9) at visit 2 and 8.0 (7.2) at visit 3 (P < .001 and P = .03, respectively). Hearing loss was significantly improved following therapy, as were laryngeal findings of reflux on fiberoptic laryngoscopy. Otitis media was considered by the examining physician to be clinically improved in 28 of 37 children (76%; 95% confidence interval, 60%-87%) at visit 2 and in 6 of 10 children (60%; 95% confidence interval, 31%-83%) at visit 3. Nine children (19.1%) required myringotomy tube placement.
Children with otitis media with effusion or recurrent acute otitis media and GERD have improved quality of life following treatment with antireflux therapy. Control of gastroesophageal reflux may play a role in the management of otitis media and avoidance of tympanostomy.
证明在诊断为复发性急性中耳炎或中耳积液合并胃食管反流病（GERD）的儿童中，采取抗反流预防措施和治疗后，经证实的中耳炎和GERD生活质量测量指标有所改善，以及通过纤维喉镜检查获得的小儿反流客观评分有所改善。
前瞻性干预前后研究。
以医院为基础的儿科耳鼻喉科诊所。
基于人群的47例患者样本（平均年龄19.5个月）。
连续两个12周的标准抗反流治疗。
中耳炎6项生活质量调查、婴儿GERD问卷修订版、幼儿GERD症状问卷、小儿反流发现评分和言语意识阈值。
37例患者有随访数据。中耳炎6项生活质量调查的平均（标准差）变化评分在第2次就诊时为1.6（1.1），在第3次就诊时为1.5（1.1）（分别为P <.001和P =.004）。婴儿GERD问卷修订版和幼儿GERD症状问卷的变化评分在第2次就诊时显著改善，婴儿GERD问卷修订版在第3次就诊时显著改善。小儿反流发现评分的平均（标准差）变化评分在第2次就诊时为6.4（4.9），在第3次就诊时为8.0（7.2）（分别为P <.001和P =.03）。治疗后听力损失显著改善，纤维喉镜检查发现的喉部反流情况也显著改善。在第2次就诊时，37名儿童中有28名（76%；95%置信区间，60%-87%）的检查医生认为中耳炎临床改善，在第3次就诊时，10名儿童中有6名（60%；95%置信区间，31%-83%）。9名儿童（19.1%）需要放置鼓膜切开置管。
中耳积液或复发性急性中耳炎合并GERD的儿童在接受抗反流治疗后生活质量得到改善。控制胃食管反流可能在中耳炎的治疗和避免鼓膜造孔术中发挥作用。
